39ODONTOLOGÍA VITAL ENERO-JUNIO 2020

Human Immunodeﬁciency Virus: Attitudes and

knowledge among health professionals in

Santiago, Chile

Human Immunodeﬁciency Virus: Attitudes and

knowledge among health professionals in

Santiago, Chile

Virus de Inmunodeﬁciencia Humana: actitudes y

conocimientos de profesionales de salud en

Santiago, Chile

Virus de Inmunodeﬁciencia Humana: actitudes y

conocimientos de profesionales de salud en

Santiago, Chile

Catalina Ugalde, Universidad Mayor, Chile, Catalina.ugalde@mayor.cl

Dafna Benadof, Universidad Andrés Bello, Chile; dafna.benadof@unab.cl

Carolina Vidal, Universidad Mayor, Chile, carolina.vidal@umayor.cl

Ernesto González, Universidad Mayor, Chile, E.gonzalezmallea@gmail.com

ABSTRACT

Introduction: Nowadays there a signiﬁcant increase of HIV cases is in Chile. It is imperative that health professionals

have the necessary knowledge to provide adequate healthcare without stigmatizing people living with HIV/AIDS.

Objective: Determine health professionals’ HIV level of knowledge and their willingness to attend people living

with this virus. Methods: This quantitative, cross-sectional study used an online self-administered survey, that

consisted on 15 questions. It evaluated the knowledge and attitudes in health professionals and technicians working

in the West Metropolitan Health Centers in Santiago, Chile. Results: The response rate was 32.7% (n=235). 86.8%

of participants said they felt safe doing medical procedures to people living with HIV, even though one out of ten

said that they related the word fear with HIV; 52.4% were unaware of the clinical guidelines of the local Ministry of

Health; and 42.7% incorrectly identiﬁed the use of double clinical gloves as a protective measure. Conclusions: The

results of this study demonstrate that it is necessary to update and reinforce the knowledge about HIV and universal

protective measures in health professionals..

KEY WORDS:

HIV, human immunodeﬁciency virus, knowledge, attitudes, health centers, health personnel, health care

providers, guidelines

RESUMEN

Introducción: En Chile existe actualmente un aumento signiﬁcativo de casos de VIH. Es imperativo que

los profesionales de la salud tengamos el conocimiento necesario para poder atender adecuadamente y sin

estigmatización a las personas que viven con VIH. Objetivos: Determinar nivel de conocimiento y disposición a

atender a personas que viven con VIH.

Métodos: Estudio transversal en el que se utilizó una encuesta online a profesionales y técnicos de salud que

trabajaban en Centros Metropolitanos de Salud Occidente en Santiago, Chile. Resultados: La tasa de respuesta

fue 32,7% (n=235). Los resultados mostraron que un 86,8% de los participantes se sentía seguro al realizar

procedimientos médicos a personas que viven con VIH, esto a pesar de que uno de cada diez relacionaba la

palabra VIH con miedo; 52,4% desconocía las pautas clínicas del Ministerio de Salud local; y el 42,7% identiﬁcó

incorrectamente el uso de doble guante como medida de protección. Conclusiones: Los resultados de este estudio

demuestran que es necesario actualizar y reforzar, en los profesionales y técnicos de la salud, el conocimiento sobre

VIH y medidas de protección universales.

PALABRAS CLAVE:

VIH, virus de inmunodeﬁciencia humana, conocimientos, actitudes, centros de salud, personal de salud,

proveedores servicios de salud, pautas.

ISSN 2215-5740

Odontología Vital Enero-Junio 2020. Volumen 1 No. 32 Año 18 https://doi.org/10.59334/ROV.v1i32.378

40 ODONTOLOGÍA VITAL ENERO-JUNIO 2020

INTRODUCTION

In the last decade HIV/AIDS in-

cidence and prevalence have di-

minished, with about 36.9 million

people living with HIV/AIDS (PL-

WHA) worldwide (UNAIDS; 2016)

(UNAIDS; 2015). Reports from the

European Union showed a stable

incidence trend of HIV from 2011

to 2015, with approximately 30000

new cases per year (Pharris, A; et

ál.; 2015).

In Chile, the annual prevalence

rate increased, between 2010 (21.4

cases for every 100.000 persons ≥13

years old) and 2015 (27.7 cases for

every 100.000 persons ≥13 years

old). The most vulnerable group

was within the adults between 20

and 29 years of age, with a preva-

lence of infection of 40.4% (Institu-

to de Salud Pública; 2016). Anoth-

er study showed that between 2008

and 2012, adolescents between 15

and 19 years of age, presented a

72% incidence of HIV notiﬁcation

(Departamento de Epidemiología;

2015). Overall, the statistics report-

ed for the Chilean population are

not promising.

To eliminate this overwhelming

number of cases, nations have in-

cluded guidelines that symbolize

the commitment to eliminate this

virus worldwide. At the core of

these programs is the 2011-2015

guide for health sectors developed

by the World Health Organization

(WHO) Global Strategies (World

Health Organization, 2011). In 2005

Chilean public policies were de-

creed to provide access and availa-

bility to HIV testing, accompanied

with counseling and treatment for

HIV carriers (Departamento de As-

esoría Jurídica; 2005) (Ministerio

de Salud de Chile; 2013). Likewise,

laws have been slowly implement-

ed in several countries to help

eliminate the discrimination and

stigma associated with carrying

this virus.

Stigma is the result of attitudes,

acknowledged or not, that is of-

ten derived from misinformation

(Foreman, M; Lyra, P; Breinbauer,

C; 2003). Literature related to at-

titudes and knowledge of health

professionals and PLWHA is in-

creasing. In the last decade, articles

in this topic have covered many

aspects. For example, some arti-

cles aim to identify factors, such as

attitudes, that affect adherence to

treatment; others to evaluate how

it affects the willingness of health

professionals to treat; and some

to focus on strategies that PLWHA

use to manage negative attitudes

towards them ( Lam, Y; et al.; 2016)

(Lee, C; et al; 2017) (Brisdon, A;

Abel, G; Desrosiers, J; 2017). Never-

theless, there are still regions in the

world where studies in this topic

are still scarce (Conejeros Vallejos,

I; et al.; 2010).

In Chile the studies assessing the

dimensions of knowledge and at-

titudes in health professionals is

limited (Ferrer, L; et al. 2015) (Irar-

rázabal, LP; 2016) (Rivas, E; 2009).

This study contributes to the liter-

ature by providing a description

of the attitudes and knowledge of

health professionals, which can

act as barriers or facilitators in the

treatment of PLWHA.

METHODS

In this cross sectional study, the

ﬁrst inclusion criteria was to be a

health professional or technician

such as physicians, dentists, mid-

wives, nurses, medical technolo-

gists or nurse technicians. They also

had to work in the West Metropol-

itan Health Service health centers

(SSMOcc) in Santiago, Chile. This

Heath Service has approximately

70 health centers, including hos-

pitals, specialty centers, emergen-

cy care and primary health care

centers.

To assess attitudes and knowl-

edge of health professionals, the

research team used a survey that

evaluated the dimensions of HIV

prevention, transmission and treat-

ment knowledge, and attitudes to-

wards treating PLWHA. The survey

covered the most relevant topics as

stated by the available literature,

the opinions of experts, and the re-

searchers’ knowledge on the topic.

Once the survey was tested and re-

tested with researchers and experts

in the ﬁeld it was showed to the tar-

get population and their opinion

was taken into account regarding

the questions and answers catego-

ries (Converse, J; Presser, S; 1996).

Lastly, the instrument reliability

and internal consistency analysis

was evaluated using Cronbach’s al-

pha calculation. Considering mini-

mum acceptable Cronbach’s alpha

0.7 and the maximum expected

value of 0.90 (Oviedo Celina, H;

Campo-Arias, A; 2005).

Researchers used the following

data collection process: 1) First-

Recibido: 1 julio, 2019

Aceptado para publicar: 5 diciembre, 2019

Ugalde, C., Benadof, D., Vidal, C. & González, E. (2020). Human Immunodeﬁciency Virus: Attitudes and knowledge

among health professionals in Santiago, Chile. Odontología Vital, 1(32), 39-44. https://doi.org/10.59334/ROV.v1i32.378

Odontología Vital Enero-Junio 2020. Volumen 1 No. 32 Año 18

41ODONTOLOGÍA VITAL ENERO-JUNIO 2020

ly, they contacted the directors of

each health center via email, they

disclosed the nature of the study

and explained that it counted with

the ethics committee approval. In

the email body, the researchers

asked for a contact list of all health

professionals that met the inclu-

sion criteria. 2) If the email was not

answered in 7 days, a researcher

from the team would call the direc-

tor to verbally ask for the informa-

tion and resolve any concerns he/

she might had about the study. 3)

All contact information was gath-

ered in an excel ﬁle with password.

4) Then an email was sent to health

professionals (n=719) inviting

them to participate in the online

survey that the researchers had

created. To access the survey all

participants had to previously read

and agree to an informed consent

document. 5) Two reminder emails

were sent to the participants dur-

ing the same month. Directors and

healthcare professionals were re-

minded that at all times their par-

ticipation was voluntary and their

answers anonymous. The ethics

committee of SSMOcc approved

this research study.

A descriptive analysis with its cor-

respondent frequency tables and

graphs was done in order to show

the distribution of the variables as-

sociated with attitudes and knowl-

edge.

RESULTS

The response rate was 32.7%

(n=235). Of these, 23 participants

did not meet the inclusion criteria

and were excluded of the study,

obtaining a ﬁnal sample of 212 par-

ticipants.

The survey started with back-

ground questions of the partic-

ipants, then there was a section

that inquired about their attitude

and knowledge about HIV. This

second segment showed moderate

reliability (Cronbach Alpha=0,615),

and no changes were made to the

survey.

Nursing technicians were the most

practiced health providers among

the responders (27.4%; n=58), con-

trary to the nurse professionals

(12.3%; n=26) that were the least.

Of the participants, 42.9% (n=91)

had practiced their profession for

less than 5 years, 23.6% (n=50) from

6 to 10 years, and 21.7% (n=46) for

more than 16 years. Most of the

health professionals indicated

that they had treated PLWHA; 73%

(n=155) recorded this experience

while working in the public health

system, 26% (n=55) in a private

clinic, and 1% (n=2) in a private

practice. Also, it is important to

mention, that 92.5% (n=196) had

not received any HIV related train-

ing during the last 6 months.

When evaluating attitudes towards

treatment of PLWHA, one out of 10

participants declared to feel fear,

and 1 out of 3 participants thought

that PLWHA were irresponsible

people (Figure 1). 90.6% (n=192)

declared their disagreement with

the statement “I should be able to

refuse to attend [PLWHA]”.

Regarding HIV related knowledge,

wearing gloves (60.4%) and masks

(43.8%) were correctly identiﬁed as

protective measures for universal

care (Figure 2). A 100% of the re-

spondents identiﬁed that the HIV

virus can spread through blood

and ﬂuids, and 94.8% said through

semen; 99.5% identiﬁed sexual

transmission as a route of HIV in-

fection; and 49.5% (n=105) knew

referral centers, within their health

network that offered treatment to

PLWHA.

Figure 1.Distribution of responses associated with HIV knowledge.

9.4%

43.8%

60.4%

42.7% 40.6%

7.8%

79.6%

99.5%

72.0%

20.4%

1.9%

100.0%

13.7%

94.8%

4.3% 2.8%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

dental cap

dental mask

clinical gloves

double clinical

glove

eyewear

clothes

parenteral

sexual

vertical

transmission

oral

contact

blood

saliva

semen

urine

tears

Safety measures Rout of HIV infection Virus spreading route

Figure 2: Distribution of attitudes towards treatment of PLWHA.

11.6%

46.3% 32.2% 34.7%

20%

40%

60%

80%

100%

Fear Pity Sense of

irresponsability Indiference

42 ODONTOLOGÍA VITAL ENERO-JUNIO 2020

On the other hand, 52.4% (n=111)

of the respondents did not know

the clinical guidelines of the Chile-

an Ministry of Health; 66% (n=140)

believed that strategies for diagno-

sis and prevention are age depend-

ent; 1.9% stipulated that HIV can

be transmitted by physical con-

tact; and 2.8% by tears and 4.3% by

urine. Finally, 42.7% of the partic-

ipants indicated that using double

glove works as barrier in case of

contagion with a sharp object.

DISCUSSION

In Chile, the third chapter of the

17.779 law, states that no public

or private health center may deny

admission or care to people in-

fected with HIV, or condition their

attention to a preliminary exam-

ination (Departamento de Ase-

soría Jurídica, 2005). Four years

after the implementation of this

law a group of researchers evalu-

ated the knowledge of a group of

health professionals in this topic.

They conducted a quasi-experi-

mental study with a control and

an educational intervention group.

The initial evaluation showed poor

results that varied between 16,3%

in knowledge about the existence

of this law to 44.7% of knowledge

about the implementation it in

their health ﬁeld. The educational

intervention group which received

eight face-to-face learning sessions

demonstrated having a signiﬁcant-

ly higher knowledge about the HIV

bill than the control group (Ferrer,

L; et al.;2011). Our study showed

that health professionals also had

limited knowledge in other top-

ics related to HIV such as the use

of double gloves as a protection

health measure. This action alone

could make people feel discrimi-

nated; therefore, it is necessary to

develop a set of educational train-

ing tools, like the one used by Fer-

rer et al, to improve knowledge in

HIV and other threatening virus

such as Hepatitis B.

Studies show that 69% to 87% of

PLWHA do not disclose their sta-

tus to their health care provider,

because they fear discrimination

or rejection (Mayﬁeld Arnold, E; et

al; 2008).Fear can act as a barrier

for seeking healthcare, and could

be increased if the healthcare pro-

fessional showed restraint as well.

In the present study, fear and will-

ingness to attend PLWHA had low

percentages; nevertheless, low

percentages are insufﬁcient, the

healthcare system should aim to

have a zero discrimination.

It is noteworthy that 92.5% of

participants had not received

any training or update in general

knowledge about HIV during the

last six months. Even though the

availability of training tools has in-

creased with time, there still is dis-

information of HIV in a large sec-

tor of society, including the health

system (Herrera, C; et al;2008). Es-

pecially considering, that in Chile

there was a 72.6% raise in the num-

ber of HIV conﬁrmed cases be-

tween 2010 and 2015 (Instituto de

Salud Pública, 2016). Other topics

that should be covered during the

training are the national clinical

guidelines of care and indications

for referral centers for treatment.

The knowledge of HIV treatment

and prevention is of extreme im-

portance for every health profes-

sional and technician. The goal

being that the treatment provided

complies with international stand-

ards, and has high levels of adher-

ence and efﬁcacy.

A limitation in this study was that

participants were mainly employ-

ees from the public health system.

The strength is that this is the ﬁrst

study to provide a basic layout

of the knowledge and attitude of

health professionals towards treat-

ment of PLWHA in Santiago, Chile.

Future research studies should aim

to determine the gaps in knowl-

edge of health professionals in

order to develop interventions

and training courses and evaluate

them. Also, research at a national

level is needed to evaluate stigma-

tization and discrimination at a

healthcare level.

Autores:

Autores

Catalina Ugalde1

Dafna Benadof2

Carolina Vidal3

Ernesto Gonzalez4

1 Facultad de Odontología, Universidad

Mayor, Chile, Catalina.ugalde@mayor.cl

2 Facultad de Odontología, Universidad

Andrés Bello, Chile; dafna.benadof@

unab.cl

3 Facultad de Odontología, Universidad

Mayor, Chile, carolina.vidal@umayor.cl

4 Facultad de Odontología, Universidad

Mayor, Chile, E.gonzalezmallea@gmail.

com

CHILE

Odontología Vital Enero-Junio 2020. Volumen 1 No. 32 Año 18

43ODONTOLOGÍA VITAL ENERO-JUNIO 2020

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